For years, doctors who worked at Sentara's 87 sites throughout the southeast complained they weren't getting a unified view of patient data.

And it wasn't for lack of technology. The Norfolk, Va.-based healthcare provider operates hospitals, nursing homes, assisted care facilities and physicians' offices in southeastern Virginia and northeastern North Carolina. It had provided doctors with patient information electronically, first using client/server tools, then a Web portal. Yet complaints persisted.

That's because the information was being pulled from a wide variety of sources, including lab, radiology, billing and registration systems, as well as a host of provider sites, according to Sam Owens, Sentara's director of systems integration.

"Trying to pull information from all of those systems and environments -- which themselves weren't heavily integrated -- was problematic," Owens said. "We wanted to provide a more concise view of clinical information to our physicians."

Sentara also had many duplicate patient records, often created during registration, Owens added. Sentara hoped a customer data integration (CDI) project would solve existing problems and lay the groundwork for a looming electronic medical records project that would better consolidate patient information, he said.

First, Sentara tried to solve the problem itself, "lashing together" systems and delving into matching technology, Owens said. But identifying patients across systems and dealing with deterministic matching algorithms was a major challenge.

Even Social Security numbers are not good unique identifiers, Owens found. During its integration effort, Sentara determined that more than 20% of its records had inaccurate or blank Social Security numbers. Recent privacy concerns had caused many patients to withhold their Social Security numbers during registration, and there was no mandate for the provider to demand them.

"People not providing their Social Security number puts more stress on your integration technology because it has to do the same thing it did before with one less piece of information," Owens said.

Finding success with CDI software

In 2003, Sentara implemented CDI software from Chicago-based Initiate Systems Inc. The CDI system runs behind the scenes to match patient data across multiple data sources, Owens explained. Earlier technology required exact matches, so a typo or incorrect birth date in an entry would return no matches. The Initiate technology uses unique algorithms to determine probable matches even if there is an error in the data entered, he said. The entire process happens in about a second.

To minimize impact on internal processes, Sentara embedded links to the new software within its existing interfaces rather than using Initiate's interfaces. This enabled easier deployment and minimal staff training. Now, after a registrar enters patient information, Initiate works behind the scenes to return a list of potentially matching patient records in a ranked order. The workflow hasn't changed, Owens said, but it's now easier for registrars to find and accurately identify matching patient records.

"We tried to limit the difference in the user interface," Owens said. "We have hundreds of registrars, and typically there's a lot of turnover in that environment, so we wanted to create a very simple model. What the end user actually sees changed very little."

Since implementing the new technology, the duplicate rate in patient records has dropped significantly -- the percentage of patients with more than one record in the system has gone from 20% to less than 2%. There is also a better audit trail of record creation, enabling Sentara to retrain registrars entering duplicates and helping the company comply with HIPAA, the Health Insurance Portability and Accountability Act. But that's just the beginning.

Laying the groundwork for EMR

The CDI project was an important foundation for Sentara's plan to implement a fully consolidated medical record for each patient. Healthcare providers are moving to these systems -- sometimes called a "computerized data repository" (CDR) or "electronic medical record" (EMR) -- to electronically consolidate data currently spread across paper records and multiple systems. Sentara is midway through its EMR project.

"The central repository concept only works if you can find the information that you have on a given patient. We had a two- to three-year head start in actually changing our processes and removing a lot of our duplicates, which has set us up very well to go into that electronic medical record model," Owens said.

Ultimately, all of this technology will support better healthcare for patients, Owens said. For example, physicians will be able to place orders for prescriptions within a new electronic system. The system's automated rules and alerts can flag problems as the physician is entering information, noting patient drug allergies or potentially negative interactions with other prescribed medications.

Owens suggested that other providers pursue similar "active" CDI systems. Other implementations he has seen keep CDI in a behind-the-scenes, passive mode -- not integrated in real time with registration systems. This means that providers find and merge duplicates only after the record has been entered. He recommends going immediately into the active mode, where the registration system is integrated with the CDI software and the entry process is modified to check for duplicate records. It's harder, he said, but it's worth it.

"Don't stop with the passive mode -- at least have a plan for going active," Owens said. "There's so much more value in stopping those [duplication] problems from happening than dealing with them after the fact."

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